Provider Demographics
NPI:1538446372
Name:NEDJATI, SUZAN
Entity type:Individual
Prefix:MISS
First Name:SUZAN
Middle Name:
Last Name:NEDJATI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4378 SEPULVEDA BLVD
Mailing Address - Street 2:# 405
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91403-3905
Mailing Address - Country:US
Mailing Address - Phone:310-770-8301
Mailing Address - Fax:
Practice Address - Street 1:4378 SEPULVEDA BLVD
Practice Address - Street 2:# 405
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91403
Practice Address - Country:US
Practice Address - Phone:310-770-8301
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-11-08
Last Update Date:2013-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53448106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist